Help for a Friend

Need advice for a friend whose husband has Type 2. My son has Type 1, so I know about diabetes from my end, but she is dealing with a lot on her end. Her husband has been diagnosed for several years but is in denial and refuses to take his meds because he doesn't like how he feels when he goes low. Obviously his meds need to be adjusted, but he won't go back to the doc. When she can get him to test he is always high - like 400 to 600 range! He is wasting away in front of her eyes - getting skinnier and skinnier, drinks liquids a lot and urinates a lot. I think he is clearly going into DKA, and so does she. When I have given her keytone test strips to have him test, he has come up with large keytones. He just says he's not going to worry about it and won't do a thing about it! I have sent over websites, links to Diabetes Powershow, etc. but he won't listen. She's at her wits end. Any advice on how to get through to him???

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Hubby and she are in a classic pattern - she nags or otherwise exerts emotional pressure and he resists. It feeds on itself and it only raises his defenses. Tell her to act casual for a change. Don't pressure him. (Acting casual is not the same as biting your lip and being obviously worried. He'll know if she's repressing the urge to nag, and that's almost as bad.)

Right now his focus is inappropriately on managing the external pressures exerted by spouse and healthcare authorities. The goal is to re-target his focus from external pressures to building his own inner resolve and awareness. In other words, to get him to "own" his condition.

To help get him there, try to catch him when he's not in a particularly defensive mood. At those times, try to influence him in non-threatening ways. This takes some creativity. Expose him again and again to key facts in ways that break familiar patterns. For example, expose him to other diabetics who ARE controlling their diabetes - in a fun way, not a support-group way. (Lure him onto this forum and others like it, for example, not by way of the diabetic threads, but some of the humorous threads.)

For another example, at an optimal time - when he is not defensive, like at a fun social event - get somebody he respects and whom he will NOT automatically oppose - a friend, a colleague, an elder, a neighbor - to give him a copy of Richard K Bernstein's Diabetes Solution. He may actually read it if he gets it that way!

Try to approach his blindside. Use humor as much as possible. People are VERY vulnerable and amenable to influence when they are laughing. :) But don't then attack - because that will only raise defenses. Give him information with the trust that he will do something with it. He needs to feel as though he is voluntarily taking up the information given him.

Specifically, he needs to:

1) really understand what's at stake 2) feel empowered to do something about it (vs. feeling defeated or apathetic)
3) know WHAT to do

...and NOT necessarily in that order.

Really understand what's at stake - he's probably got too many defenses against this one already. People have been warning him from day one, probably. He doesn't need this reinforced at this point.

Number 2 is critical. He must feel both emotionally and logistically empowered (as in, not feeling helpless, and actually having all the supplies there and a way to easily learn how to use them). The Bernstein book is great in that sense - it reassures readers that they have the power and that ONLY they have the power to take responsibility for their health, and it tells 'em exactly what to do.

Knowing what to do goes hand-in-hand with being empowered. Realizing that normalizing blood sugars is possible and actually yields the only clear path to hope that many diabetics have these days is a biggie.

Yeah what Teld said. You can't force anyone to take better care of themselves. They have to want to do it. We have all heard the saying that you can lead a horse to water but you can't make him drink. I say there is nothing that says he won't. She should try gently leading him and remember that trying to force him will do no good. It would be like trying to force a child to eat something they don't want to eat.

I would try getting him to see that he can feel better and that the situation is not hopeless. You have to make him want to do better not force him to see the error of his ways

Teld and Sternwinder are very kind, and are probably right. Maybe this kind of strategy does work. I would not have the patience for it, however. I'd probably just ask if his life insurance was paid up and ask how he'd like to be buried and what he'd like me to have at his memorial. And then I would grant him total responsibility for his own life and stop letting him drag me down. I'll be interested to see what other TuD people have to say, maybe those who have dealt with this. It just feels wrong to me to put yourself in a position - whether you're being sneaky or overt - where you think you have to manipulate another adult's behavior.

What I'm thinking is, if the goal is to get him to change and he doesn't want to, then exerting influence - manipulating, as you say - could work. Most of us manipulate other adults all the time, unconsciously if not consciously. We're constantly negotiating things in our work, personal relationships, professional associations, etc. Part of being human and all that. Doing something consciously to influence someone else is a legitimate strategy to me - it actually leads to LESS unconscious manipulation, or even replaces it - and it's not always a bad thing.

But if, on the other hand, the goal is to let him do whatever he wants and not be bothered, under the assumption that the issue isn't worth bothering about or that one CAN'T or SHOULDN'T consciously influence another person, then probably her focus should be on altering her own mood or divesting herself of attachment to him. That works, too. But just from that one description, though, it sounds like she's deeply vested in his survival - spouses can be funny that way! - and won't be content with the latter.

I've taken both positions - get involved, don't get involved - with various people close to me who were doing destructive things to themselves. It all depends on 1) the type of relationship, 2) how much potential there is to really affect the person, which depends on how firmly situated are the habits, the sorts of personalities involved, that kinda thing, and 3) the type or level of commitment defining the relationship.

I'm not surprised! If he's usually 400-600, even coming down to 300 would probably feel awful as his body isn't used to it. It's something that does pass with time as one's body gets adjusted to more normal BGs. I'd be inclined to at least give him that information, but I agree - you can't change someone else, just give them enough information to make an educated choice.

That's a tough one. I agree with both Teld and Jan. Nothing short of him owning his D will bring about the needed change. The problem is his. But his actions affect everyone around him. Thing is, arriving at that point is as individual as this disease.

I was in denial for years. I didn't have insurance or a big income and did not want a diagnoses that could be an albatross. Getting me to a doctor, and a diagnoses, was something of an intervention. Like your friend's husband I was wasting away (145lb at over 6 ft) and had already developed some bad complications. Staying alive and reversing my complications has been my motivation. He really needs to understand that all the complications are inevitable if he keeps the course he is on. Getting him there is the problem.

Teld has some great methods for accomplishing that. If those don't work, Jan has the only option. Get your house in order and make plans for a very unpleasant and short, future.

After 26 years not really dealing with issue, got stroke from not really dealing with properly. That fixed me. It took 4 years to wrestle mess back to ground.

Got on 1200 calorie diet, 2 miles walking a day and metformin with proper metering and was able to get a1c dowm from 13.3 to 6.4. Weight finally came down from 330 to 240 pounds. Eyes cleaned up with hemorages gone, kidneys stabalized, off the actos/starlix/glyburide. Under proper diet, exercise, metering and insulin - lows and weight are controllable.

Under starlix/glyburide - that can be a fracas.

I am not Doctor and you need a good Doctor -Diabetes Team to advise and assist you.

See my book "At the Precipice" by Jim Snell. I can send one.

I would offer to the good man - please do not do your current approach any longer. Unless dead in box, it is NEVER to late to change and stop the rot.

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